Author: Laurie Wertich
Cancer survivorship can be
accompanied by a unique
set of emotions—joy, grief,
fear, relief, deep gratitude, a
heightened sense of purpose, and an overwhelming
sense of responsibility to live life
to the fullest.
But there is another nagging feeling that
can sneak into the mix: guilt. Survivorship
is such a blessing, yet in spite of that blessing,
we often find ourselves reflecting on
those who have not been as fortunate.
The first question that many people ask
in the face of a cancer diagnosis is Why me? This is a normal response to such an
overwhelming diagnosis. Why did I get this
disease? Why am I sick when others are not?
Why do I have to endure this treatment?
Though generally unanswerable, it is a
completely reasonable question.
In the shift from diagnosis to treatment
and on to recovery, the primary question
changes. More often than not, most cancer
patients move pretty quickly from Why
me? to What’s next? What do I need to do to
survive? How can I best care for myself during
treatment? What will I do with my precious
life after treatment?
Here’s where it gets interesting: in the
face of survivorship, many patients find
themselves also circling back around to
that first question as they move beyond
diagnosis to treatment and recovery, only
this time Why me? carries with it a twinge
of guilt and sadness. Why did I survive
when others did not? Why was I so lucky?
What is survivor guilt?
Survivor guilt is common among survivors
of traumatic events—such as war, natural
disasters, accidents, and even acute or longterm
illnesses such as cancer. Survivor guilt
refers to the sense of guilt or responsibility
that can occur when one person survives a
traumatic event that others did not. And,
yes, cancer can be a traumatic event.
“Not all of our patients experience cancer
as a traumatic event,” explains Rhonda Colley,
MS, LPT, LMFT, a mind-body therapist
at Cancer Treatment Centers of America®
(CTCA) in Tulsa, Oklahoma. “But even if
they aren’t traumatized, they can still experience
survivor guilt, which means basically
feeling guilty that they got through this treatment journey relatively unscathed.”
Colley works with a lot of survivors who
are experiencing some level of guilt. “We call
it ‘imagined guilt’ or ‘survivor guilt,’” she
says. “Sometimes patients feel responsible
in part for the passing of fellow patients.”
This may not make sense to someone
who has not walked the cancer path, sat
with fellow patients in the waiting room,
compared diagnoses and treatment plans,
and given and received encouragement
throughout the journey. But to a cancer
survivor, it makes perfect sense, and it is
another part of the cancer journey that
must be processed.
Who experiences survivor guilt?
There is a sense of implied comparison
that occurs among people who have endured
similar ordeals. It’s only natural to
compare type and stage of cancer, treatment
plans, nutrition plans, and more. It’s
what we do—we find common ground, especially
in the face of cancer—because we
need one another.
“We have an amazing support community
at CTCA®,” Colley says. “Our patients
seek each other out in the cafeteria and the
waiting rooms. They gravitate toward one
another. But because of that tight bond,
they might be more inclined to feel a sense
of survivor guilt.”
Colley explains that CTCA patients
form deep connections. “They may have
the same type and stage of cancer, and then
they go through treatment and one has a
Sometimes in these cases, but not always,
survivor guilt ensues. Some patients
develop a sense of guilt or responsibility—
believing that they should have helped the
other patient survive or, worse, that they
should have been the one to pass away.
Some survivors will get stuck in a vicious
cycle of “if only”: If only I had told her about
the special vitamins I was taking. If only I
had encouraged him to try acupuncture. If
only I had worked harder to build hope in
“Some people experience no survivor
guilt, and others are overwhelmed by it,”
Colley explains. “Many times it’s something
that may be operating at a deeper
level, and the person is not even aware that
they have it.”
Coping with survivor guilt
Though some refer to survivor guilt as
imagined guilt, that’s not to say it isn’t real.
“We do not invalidate anyone’s feelings.
Feelings are very real,” explains Colley.
“The feeling of guilt is real, but the foundation
of it is imagined.”
With that in mind, often the first step
in coping with survivor guilt is to examine
the foundation of the guilt. A mind-body
therapist can be instrumental in this process.
“I really encourage patients to talk to
us about their feelings regarding other patients,”
Colley says. “Sometimes it is a big
help just to verbalize the feelings.”
Colley says that she asks patients to be
willing to hear feedback: “We mirror back
to them what we are hearing them say—
which is that they are experiencing something
that is understandable but unfounded.”
She says that it is important to examine
the feelings and understand that they
are real—but unrealistic. “We ask them to
really think about how they arrived at this
conclusion that they should have been able
to help this other person survive.”
Colley encourages patients to examine
their feelings of guilt by journaling, talking
to a therapist, or participating in a
support group. “I like to get patients connected
to groups because that can help
give them a constant sense of balance,”
What’s more, Colley says that one of
the most effective ways to move beyond
survivor guilt is to look ahead and try
to bring something good out of the experience.
“What could a survivor do that
would be productive and fruitful going
forward?” she asks.
Survivorship presents an opportunity
to leave regrets behind and reprioritize
life in a new way. Sometimes this means
making drastic changes, but sometimes it
can be as simple as planting a tree in honor
of a fellow patient who did not survive.
This too shall pass
The good news is that survivor
guilt typically fades with time. It
is important to acknowledge and
accept the feelings of guilt—and
allow yourself to move beyond
them. You deserve to survive
and thrive and enjoy your
one wild and precious